CONFIDENTIAL

APPLICATION FOR EMPLOYMENT

Strategic Advice and Support Project Development Officer

We welcome applications from all sections of the community.

If you are handwriting this application please use black ink

PERSONAL DETAILS
Surname………………………………………………………… Title ......
Forename(s) ......
Address ......
......
......
Preferred telephone contact number. (h)……......
(w)………………………………………………..(m)......
Preferred email address: ......
PRESENT EMPLOYMENT
Job Title:……………………………………………. Date Commenced:……………………
Employer’s Name and Address ......
......
......
......
Present Salary ......
Length of Notice Required ......
Please describe the duties, and responsibilities of your present/most recent job. Indicate to whom you are/were responsible and those responsible to you.
PREVIOUS EMPLOYMENT
(Most recent first – please give exact employment dates)
Continue on separate sheet if necessary
Employer’s name and address / Position held / Dates
FromTo / Reason for leaving
EDUCATIONAL DETAILS
(Give details of Education since age 16. Include academic, vocational and professional qualifications and awards)
School, College, University / Dates
FromTo / Qualification and Grades
Qualifications currently being pursued
/ Level / Expected completion date
TRAINING/LEARNING
Please give details of training received or courses attended which you consider relevant to your application.
Membership of Professional bodies, Societies or Institutions
FURTHER INFORMATION
(Continue on a separate sheet if necessary but do not exceed two A4 sides)
Please indicate how you match the requirements of the post as contained in the person specification. Please include details of activities outside work if relevant to the post being applied for.
Please tell us why you want to work for this sector and particularly, this organisation
Where did you hear about this vacancy?
REFERENCES
Please give names and addresses of two referees, one of whom must be your present/most recent employer and one other person who would know you in connection with your work. Please indicate if you are known to your referee(s) by a different name.

1…......
......
Capacity in which you are known to them:………………………….Tel.No: …………..…
Email address: ......

2 ......
......
Capacity in which you are known to them:…………………..………Tel No: …………..…
Email address: ......
References for shortlisted applicants may be taken up prior to an interview. If you do not wish your referee(s) to be contacted at this stage, place an “X” in the appropriate box(es).
DECLARATION
  1. I acknowledge that an appointment, if offered, will be subject to satisfactorily medical clearance/references/compliance with the Asylum & Immigration Act.
  1. I declare that the information given on this form is correct and understand that on appointment any misleading statements or deliberate omissions may be regarded as grounds for dismissal.
  1. I acknowledge that any information submitted in pursuit of my application may be held on computer and manual files and therefore falls within the provisions of the Data Protection Act.

Signature:…………………………………………….. Date………………………………………

Please return completed application form to:

Lynne Harrison, Shared Lives Plus

GO4 The Cotton Exchange,Old Hall Street, Liverpool, L3 9JR

Please note that CVs will not be accepted

Tel: 0151 227 3499 Fax: 0151 236 3590

EQUALITY OF OPPORTUNITY MONITORING FORM

In order to monitor the effectiveness of our Equal Opportunities Policy, we would request that all applications provide the following information, which will be treated as confidential. This information will not be used in any part of the recruitment process other than for statistical monitoring. It will be detached from the application form prior to short-listing.

Job Applied for:
Your Full Names:
1. Date of Birth
2. Gender / Female / Male / Prefer not to say
3. Have you ever identified as transgender? / Yes / No / Prefer not to say
For the purpose of this question, “transgender” is defined as an individual who lives, or wants to live, full time in the gender opposite to that they were assigned at birth.

4.Your sexual orientation

Bisexual / Heterosexual
Gay man / Prefer not to say
Gay woman / lesbian / Other (specify if you wish):

5.Your race or ethnic origin

Asian or Asian British / Mixed
Bangladeshi / White and Asian
Indian / White and Black African
Pakistani / White and Black Caribbean
Any other Asian background / Any other Mixed background
Black or Black British / White
African / British
Caribbean / Irish
Any other Black background / Any other White background
Chinese or other ethnic group
Chinese / Other (specify if you wish):
Prefer not to say

6. Your religion or belief

Which group below do you most identify with?

No religion / Jewish
Baha’i / Muslim
Buddhist / Sikh
Christian / Prefer not to say
Hindu / Other (specify if you wish):
Jain
7. Do you consider yourself to have a disability according to the terms given in the DDA? / Yes / No / Prefer not to say
The Disability Discrimination Act 1995 (DDA) protects disabled people. The DDA defines a person as disabled if they have a physical or mental impairment, which has a substantial and long term (i.e. has lasted or is expected to last at least 12 months) and has an adverse effect on the person’s ability to carry out normal day-to-day activities.

Registered Charity Number (England and Wales):1095562 Registered Charity Number (Scotland): SC042743.

1Company no: 4511426